目的 探讨外伤性脾破裂手术适应证和方法。方法 对77例外伤性脾破裂进行保脾手术治疗，按姜洪池脾损伤四级分类法： Ⅰ级8例，Ⅱ级41例，Ⅲ级18例，Ⅳ级10例。附加脾动脉结扎术6例。结果 死亡4例； 2例并粘连性肠梗阻。获随访45例，随访时间3个月至3年，仅4例儿童有反复上呼吸道感染，无1例发生脾切除后凶险感染(OPSI)。结论 根据脾损伤的部位和程度，可采用两种以上的联合保脾术式，对控制伤脾出血及保留脾脏功能有重要价值。
ObjectiveTo explore the security and advantages of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for occupancy lesions in pancreatic body and tail. MethodsA total of 97 patients with occupancy lesions in pancreatic body and tail who underwent laparoscopic distal pancreatectomy in our hospital from June 2010 to August 2014 were collected retrospectively, and were divided into LSPDP group (n=60) and laparoscopic distal pancreatectomy with splenectomy (LDPS) group (n=37) according to the surgery, clinical effect was compared between the 2 groups. ResultsThe operations got well in all patients, no one died during perioperative period. The operation time was shorter in LSPDP group than that of LDPS group[(190.83±66.39) min vs. (224.46±83.23) min, P=0.030], but there was no significant difference between LSPDP group and LDPS group in the blood loss[45.35 mL vs. 54.92 mL], hospital stay[(8.38±4.06) d vs. (9.76±4.54) d], incidence of total postoperative complication[23.33% (14/60) vs. 13.51% (5/37)], and degree of postoperative complication (P>0.050). There were 86 patients were followed up for 3-54 months, with the median time of 18 months. For patients with tumor, no one suffered from recurrence, metastasis, and death during the follow-up period, and other patients with benign diseases had an excellent prognosis. ConclusionFor occupancy lesions in pancreatic body and tail, LSPDP is feasible and safe.
ObjectiveTo study the indication and means in dissection lymph nodes of the No.10 and No.11 without splenectomy in radical gastrectomy for gastric cancer. MethodsAccording to the location, type of pathology, clinical and pathological classification, lymphatic drainage and spread of gastric carcinoma togather with the immunological function of spleen, selection of operative procedure without splenectomy should be considered, so the related literatures were reviewed. ResultsRetained spleen had been shown to improve 5year survival of patients with gastric cancer of stage Ⅰ,Ⅱ and Ⅲ,splenectomy had been shown to improve 5year survival of patients with gastric cancer of stage Ⅳ,whose carcinoma was infiltrating splenic and the lymph nodes of the No.10. The complications of different means of dissection of the lymph nodes made no difference.Conclusion Dissection of the lymph node without retained spleen or allogenic spleen transplantation is indicated for the patients with cancer of stage Ⅳ,whose spleen is invaded by the tumor.
Objective To evaluate feasibility and clinical application value of laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Method The clinical data of 17 patients underwent LSPDP from January 2015 to June 2017 in this hospital were retrospectively analyzed. Results The LSPDP was successfully completed in the 17 cases, with Kimura procedure and Warshaw procedure were performed in the 12 cases and 5 cases, respectively. The operative time was (218±60) min, the intraoperative blood loss was (136±114) mL, the time to get out of bed after surgery was (1.4±0.6) d, the postoperative fasting time was (2.0±0.8) d, and the postoperative hospital stay was (13.4±5.7) d. The rate of the postoperative pancreatic fistula was 17.6% (3/17). The spleen infarction occurred in the 2 cases following the Warshaw procedure. The pathologic examination showed that there were 2 patients with the serous cystadenoma, 7 patients with the mucinous cystadenoma, 3 patients with the solid pseudo-papillary tumor, 3 patients with the intraductal papillary mucinous cystadenoma neoplasm, and 2 patients with the insulinoma. All the patients were followed-up for 5 to 26 months (average 13 months), and the perigastric varice occurred in 1 patient, no recurrence or spleen infarction occurred during the following-up. Conclusion LSPDP is a safe, feasible and effective method with less injury and rapid recovery.